Neonatal Anesthesia

Neonates undergo 1.5 million anesthetics for surgical procedures in the United States every year. Common surgical procedures for neonates include central line placement, ventriculoperitoneal (VP) shunt placement, tracheostomy, gastrostomy tube placement, circumcision, and inguinal hernia repair. Neonates are also at risk for necrotizing enterocolitis (NEC) and frequently have intraperitoneal drains placed or need an exploratory laparotomy with possible bowel resection. Patients with NEC are some of the sickest babies for which pediatric anesthesiologists will care. Some babies are born with problems that put them at risk for needing imaging or surgical procedures early in life, such as tracheoesophageal fistula, congenital diaphragmatic hernia, gastroschisis, omphalocele, and pyloric stenosis. There are about 40,000 infants born with congenital heart disease every year. A small percentage of these babies will need a Blalock-Taussig (BT) shunt in the first few days of life to maintain circulation compatible with life.

It is common across the United States for general anesthesiologists to take care of children 2 years of age and older for basic surgical procedures when they are otherwise reasonably healthy, meaning the American Society of Anesthesiology (ASA) Physical Class I or II. Children under 2, ASA class III and higher, and neonates (babies < 1 month of age) are most often cared for by pediatric anesthesiologists, which is a board-certified subspecialty of the American Board of Anesthesiology. Common considerations for neonates in the operating room (OR) include temperature control, glucose management, positioning, blood loss, and circulating blood volume. Bedside cases are performed in the neonatal intensive care unit when neonates are deemed too unstable for transport to the operating room; this is most often due to blood pressure instability (low blood pressure) and/or respiratory failure requiring high flow oscillatory ventilation (HFOV). Other considerations for neonates undergoing anesthesia include intubation and airway management, respiratory system and metabolic oxygen requirements, cardiovascular system physiology, and pharmacology and drug metabolism physiology.